Laboratory Studies
Perform a thorough physical examination, not limited to just the head and neck region, to uncover associated anomalies in the infant presenting with an orofacial cleft. Additional workup is determined by physical findings that suggest involvement of other organ systems.
The child's weight, oral intake, and growth and/or development are of primary concern and must be followed closely.
Routine laboratory studies typically are not required, other than a hemoglobin study shortly before the planned lip repair.
Routine imaging is not indicated in a healthy patient with isolated cleft lip.
Lip repair should await the resolution of any acute illnesses, including cold viruses resulting in rhinorrhea, as this may interfere with proper lip care postoperatively and contribute to complications.
-
Bilateral cleft lip repair. (A) The prolabial width is typically set at 4-5 mm. (B) The prolabial flap is elevated to the base of the columella. The adjacent flaps are turned over to create a labial sulcus. (C) The orbicularis oris muscle, dissected from the overlying skin, is approximated across the midline. (D) The skin is approximated, and the Cupid's bow is created from the lateral vermilion flaps.
-
Intraoperative technique. (A) The anatomic landmarks are tattooed and the planned incisions are marked. (B) The orbicularis is dissected from the overlying skin and divided into bundles to allow interdigitation with its opposing element. Inferiorly, an element of the muscle is left attached with the triangular vermilion flap used to create a Cupid's bow. (C) The prolabial flap is developed. The lateral lip elements of the prolabium are discarded and the mucosal flaps are turned over to create a labial sulcus. (D) The lower lateral cartilages are freed from the overlying nasal skin from the base of the ala and columella. The nasal domes are approximated to each other and the cartilages are suspended from the upper lateral cartilages. (E) The series of interdigitating bundles of the orbicularis muscle are approximated to each other. (F) The skin is inset with a series of fine nylon sutures, which are removed 5-7 days postoperatively if a skin adhesive is not used. Xeroform gauze bolsters are placed as a temporary nasal stent.
-
Preoperative and postoperative images of a child born with a complete bilateral cleft lip and palate. Note that the prolabial width increases because of the tension. Ideally, the initial width should have been set narrower.
-
Preoperative and postoperative images of a child born with a complete bilateral cleft lip and palate.
-
Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.
